Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
Medicina (Kaunas). 2023 Jul 4;59(7):1243. doi: 10.3390/medicina59071243.
: Although radiofrequency ablation (RFA) is widely used as an effective local treatment for hepatocellular carcinoma (HCC), evidence on salvage hepatectomy for local recurrence after RFA is limited. This study aims to compare open and laparoscopic approaches in salvage hepatectomy for recurrent HCC after RFA. : Among patients who underwent hepatectomy between January 2004 and August 2022 at a single tertiary referral center, 55 patients who underwent salvage hepatectomy for marginal recurrence after RFA were selected. An open approach was used in 23 (41.8%) patients, while 32 (58.2%) patients underwent laparoscopic surgery. Short-term and long-term outcomes were compared between the two groups. : Major hepatectomy was more often performed in the open group (9 [39.1%] vs. 4 [12.5%], = 0.022). Intraoperative blood loss was also greater in the open group (450 (325-750) vs. 300 (200-600), = 0.034). Operation time ( = 0.144) and postoperative morbidity rates ( = 0.639) were similar, and there was no postoperative mortality in either group. Postoperative hospital stay was significantly longer in the open group compared to the laparoscopy group (8 (6-11) days vs. 5 (4-7) days, = 0.028). The 1-, 3-, and 5-year disease-free survival rates showed no difference between the two groups (44.6% vs. 62.5%, 16.5% vs. 13.5%, and 8.3% vs. 13.5%, respectively; = 0.154). The 1-, 3-, and 5-year overall survival rates between the two groups were also similar (85.7% vs. 96.8%, 79.6% vs. 86.0%, and 79.6% vs. 79.4%, respectively; = 0.480). : Laparoscopic salvage hepatectomy shows oncologic outcomes comparable to the open approach with faster postoperative recovery rates. Considering that recurrence rates are high after RFA, the laparoscopic approach should be considered as a first-line option in selected patients.
尽管射频消融 (RFA) 被广泛用作治疗肝细胞癌 (HCC) 的有效局部治疗方法，但关于 RFA 后局部复发行挽救性肝切除术的证据有限。本研究旨在比较 RFA 后复发 HCC 行挽救性肝切除时开放手术与腹腔镜手术的效果。
在单中心的一家三级转诊中心，2004 年 1 月至 2022 年 8 月期间行肝切除术的患者中，选择了 55 例因 RFA 后边缘复发而行挽救性肝切除术的患者。23 例 (41.8%) 患者采用开放手术，32 例 (58.2%) 患者行腹腔镜手术。比较两组的短期和长期结果。
在开放组中更常进行主要肝切除术 (9 例 [39.1%] vs. 4 例 [12.5%]， = 0.022)。开放组术中出血量也更大 (450 (325-750) vs. 300 (200-600)， = 0.034)。手术时间 ( = 0.144) 和术后并发症发生率 ( = 0.639) 相似，两组均无术后死亡。与腹腔镜组相比，开放组的术后住院时间明显更长 (8 (6-11) 天 vs. 5 (4-7) 天， = 0.028)。两组的 1、3 和 5 年无疾病生存率无差异 (44.6% vs. 62.5%，16.5% vs. 13.5%，8.3% vs. 13.5%； = 0.154)。两组的 1、3 和 5 年总生存率也相似 (85.7% vs. 96.8%，79.6% vs. 86.0%，79.6% vs. 79.4%； = 0.480)。
腹腔镜挽救性肝切除术的肿瘤学结果与开放手术相当，且术后恢复更快。考虑到 RFA 后复发率较高，腹腔镜手术应作为选择患者的一线治疗方案。
